Arterial hypertension associated with PARPi: A meta-analysis of 41 placebo randomized controlled trials combined with a World Health Organization's pharmacovigilance study

IF 2.1 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Clémence Blaize, Ellina Surtouque, Jonaz Font, Charles Dolladille, Sophie Postel-Vinay, Angélique Da Silva, Joachim Alexandre, Pierre-Marie Morice
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引用次数: 0

Abstract

Background

Arterial hypertension has been recently reported from randomized controlled trials (RCTs) assessing poly (ADP-ribose) polymerase inhibitor (PARPi).

Objective

In a context of increasing use of PARPi, it is crucial to properly assess risk and incidence of this adverse event for clinical practice.

Methods

We performed a systematic review and meta-analysis in MEDLINE, Cochrane CENTRAL and ClinicalTrials.gov up to January 4, 2023 with an ongoing surveillance up to June 7, 2023. RCTs comparing PARPi to placebo in adult patients with solid tumors were included if hypertension was reported. The primary outcome was the summary risk ratio (RR, with 95% CIs) of any hypertension of PARPi class in placebo RCTs. Secondary outcomes were the summary risk and incidence of hypertension of each individual PARPi. To provide clinical features of PARPi-associated hypertension, we independently queried the WHO's pharmacovigilance database, up to September 1, 2022.

Results

In total, 41 placebo RCTs (n = 15 264 adult patients) were included. PARPi class was not associated with an increased risk of hypertension compared with placebo. In individual analyses, the risk of hypertension was lower with olaparib than placebo (RR 0.77 [95% CI: 0.68–0.86], P < 0.01; I2 = 19%, χ2 P = 0.26). Niraparib monotherapy increased the risk of any (RR 2.84 [95% CI: 1.76–4.57], P < 0.01; I2 = 66%, χ2 P = 0.01) hypertension with a summary incidence of 19.87% (95% CI: 15.23–25.50). In real-life setting, niraparib-associated hypertension occurs within 20 days and was serious in 66%. Co-prescription of at least one antihypertensive or therapy-induced hypertension was reported in 20.5% or 14.4% of cases, respectively.

Conclusions

In a context of extensive assessment of niraparib in combination, these data reinforce the need of a close monitoring of this adverse event to preserve its clinical benefit on patients' survival.

与 PARPi 相关的动脉高血压:41 项安慰剂随机对照试验与世界卫生组织药物警戒研究的荟萃分析。
背景:最近,评估聚(ADP-核糖)聚合酶抑制剂(PARPi)的随机对照试验(RCT)报告了动脉高血压:在越来越多地使用 PARPi 的情况下,正确评估这一不良事件的风险和发生率对于临床实践至关重要:截至 2023 年 1 月 4 日,我们在 MEDLINE、Cochrane CENTRAL 和 ClinicalTrials.gov 上进行了系统回顾和荟萃分析,并持续监测至 2023 年 6 月 7 日。如果报告了高血压,则纳入在实体瘤成年患者中比较 PARPi 和安慰剂的 RCT。主要结果是安慰剂 RCT 中 PARPi 类任何高血压的总风险比 (RR,含 95% CIs)。次要结果是每种 PARPi 的高血压总风险和发病率。为了提供 PARPi 相关高血压的临床特征,我们独立查询了世界卫生组织的药物警戒数据库(截至 2022 年 9 月 1 日):结果:共纳入 41 项安慰剂 RCT(n = 15 264 名成年患者)。与安慰剂相比,PARPi 类药物与高血压风险增加无关。在单项分析中,奥拉帕利的高血压风险低于安慰剂(RR 0.77 [95% CI:0.68-0.86],P 2 = 19%,χ2 P = 0.26)。尼拉帕利单药治疗会增加任何高血压的风险(RR 2.84 [95% CI:1.76-4.57],P 2 = 66%,χ2 P = 0.01),总发生率为 19.87%(95% CI:15.23-25.50)。在现实生活中,尼拉帕利相关高血压发生在 20 天内,66% 的患者病情严重。据报道,20.5%或14.4%的病例同时服用了至少一种降压药或治疗引起的高血压:结论:在对尼拉帕利联合用药进行广泛评估的背景下,这些数据强化了密切监测这一不良事件的必要性,以保持其对患者生存的临床益处。
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来源期刊
CiteScore
5.30
自引率
6.90%
发文量
111
审稿时长
6-12 weeks
期刊介绍: Fundamental & Clinical Pharmacology publishes reports describing important and novel developments in fundamental as well as clinical research relevant to drug therapy. Original articles, short communications and reviews are published on all aspects of experimental and clinical pharmacology including: Antimicrobial, Antiviral Agents Autonomic Pharmacology Cardiovascular Pharmacology Cellular Pharmacology Clinical Trials Endocrinopharmacology Gene Therapy Inflammation, Immunopharmacology Lipids, Atherosclerosis Liver and G-I Tract Pharmacology Metabolism, Pharmacokinetics Neuropharmacology Neuropsychopharmacology Oncopharmacology Pediatric Pharmacology Development Pharmacoeconomics Pharmacoepidemiology Pharmacogenetics, Pharmacogenomics Pharmacovigilance Pulmonary Pharmacology Receptors, Signal Transduction Renal Pharmacology Thrombosis and Hemostasis Toxicopharmacology Clinical research, including clinical studies and clinical trials, may cover disciplines such as pharmacokinetics, pharmacodynamics, pharmacovigilance, pharmacoepidemiology, pharmacogenomics and pharmacoeconomics. Basic research articles from fields such as physiology and molecular biology which contribute to an understanding of drug therapy are also welcomed.
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